Prognostic value of normal regadenoson stress perfusion cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance

Amit R Patel²  Roberto M Lang²  Michael H Davidson⁴  Sara M Tanaka⁴  Sonal Chandra¹  Kevin P Cavanaugh⁴  Kristen M Turner⁴  Emily R Zaran⁴  Victor Mor-Avi⁴  Peter Czobor⁴  Nicole M Bhave³  Akhil Narang⁴  Benjamin H Freed¹ 

[1] Department of Medicine, Northwestern University, Chicago, IL, USA;Department of Radiology, University of Chicago, MC 5084, 5841 S Maryland Ave., Chicago, IL 60637, USA;Department of Medicine, University of Michigan, Ann Arbor, MI, USA;Department of Medicine, University of Chicago, Chicago, IL, USA

关键词: Regadenoson;    Myocardial perfusion;    Cardiovascular magnetic resonance;   

Others  :  802044
DOI  :  10.1186/1532-429X-15-108

 received in 2013-02-11, accepted in 2013-12-10,  发布年份 2013

【 摘 要 】

Background

Regadenoson is a vasodilator stress agent that selectively activates the A_2A receptor. Compared to adenosine, regadenoson is easier to administer and results in fewer side effects. Although extensively studied in patients undergoing nuclear perfusion imaging (MPI), its use for perfusion cardiovascular magnetic resonance (CMR) is not well described. The aim of this study was to determine the prognostic value of a normal regadenoson perfusion CMR in patients with known or suspected coronary artery disease.

Methods

Patients with known or suspected coronary artery disease were prospectively enrolled to receive perfusion CMR (Philips 1.5 T) with regadenoson. Three short-axis slices of the left ventricle (LV) were obtained during first pass of contrast using a hybrid GRE-EPI pulse sequence (0.075 mmol/kg Gadolinium-DTPA-BMA at 4 ml/sec). Imaging was performed 1 minute after injection of regadenoson (0.4 mg) and repeated 15 minutes after reversal of hyperemia with aminophylline (125 mg). Perfusion defects were documented if they persisted for ≥2 frames after peak enhancement of the LV cavity. CMR was considered abnormal if there was a resting wall motion abnormality, decreased LVEF (<40%), presence of LGE, or the presence of a perfusion defect during hyperemia. All patients were followed for a minimum of 1 year for major adverse cardiovascular event (MACE) defined as coronary revascularization, non-fatal myocardial infarction, and cardiovascular death.

Results

149 patients were included in the final analysis. Perfusion defects were noted in 43/149 (29%) patients; 59/149 (40%) had any abnormality on CMR. During the mean follow-up period of 24 ± 9 months, 17/149 (11.4%) patients experienced MACE. The separation in the survival distributions for those with perfusion defects and those without perfusion defects was highly significant (log-rank p = 0.0001). When the absence of perfusion defects was added to the absence of other resting CMR abnormalities, the negative predictive value improved from 96% to 99%.

Conclusion

Regadenoson perfusion CMR provides high confidence for excellent prognosis in patients with normal perfusion.

【 授权许可】

   
2013 Freed et al.; licensee BioMed Central Ltd.

【 图 表 】

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